Implicit rationing of nursing care reported by nurses from different types of hospitals and hospital units.

AIMS AND OBJECTIVES: The study aimed to investigate differences in assessing implicit rationing of nursing care by Czech nurses with respect to the type of unit and type of hospital. BACKGROUND: Implicit rationing of nursing care may differ across different types of hospitals and hospital units. DESIGN: This study used a multicentre cross-sectional study design. METHODS: The STROBE checklist for observational cross-sectional studies was followed for reporting of the research study. The sample included 8209 nurses providing direct care to medical and surgical patients in 14 acute care Czech hospitals. The main outcome was implicit rationing of nursing care as measured with a Czech version of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument. Data were collected from September 2019 to October 2020. RESULTS: The most frequently rationed nursing care activity was timely response to patient or family request/need, followed by emotional or psychological support and adequate supervision of delegated tasks. More implicitly rationed nursing care was reported in medical units. Statistical differences were found in rating 25 items and the PIRNCA total score. Nurses from middle-sized hospitals reported implicitly rationed care more frequently than those from large hospitals. CONCLUSION: More rationed care was reported by nurses from medical units and nurses from middle-sized hospitals. Organisational variables (the type of unit and type of hospital) influence the implicit rationing of nursing care in our study. RELEVANCE TO CLINICAL PRACTICE: The findings call for nursing managers to pay attention to organisational variables which may affect the implicit rationing of nursing care.

Hospital and unit variables of missed nursing care in acute care hospitals: A cross-sectional study.

AIMS AND OBJECTIVES: To investigate hospital, unit and staff variables as the correlates of missed nursing care (MNC) in Czech hospitals. BACKGROUND: There is a considerable variability in patterns of MNC across different hospital, unit and staff characteristics. DESIGN: A cross-sectional study was conducted. The STROBE guidelines for reporting observational studies were followed for reporting of the research study. METHODS: A sample of 513 nurses working in nine acute care hospitals was recruited. MNC activities were measured with the MISSCARE Survey. Data were analysed using descriptive statistics and univariate logistic regression. RESULTS: Type of unit was confirmed as a significant predictor of MNC. Staff characteristics (nurses' work position, level of education and perceived adequacy of unit staff) and hospital variables did not contribute significantly to MNC. CONCLUSIONS: The study replicated the patterns of MNC across different conceptual approaches. MNC was influenced by work environment characteristics rather than individual staff variables. RELEVANCE TO CLINICAL PRACTICE: The results of this research showed that missed nursing care is influenced by work environment characteristics rather than individual staff variables.

Core Evidence-Based Practice Competencies and Learning Outcomes for European Nurses: Consensus Statements.

BACKGROUND: Consensus on evidence-based practice (EBP) competencies and associated learning outcomes for registered nurses has not yet been achieved in the European context. AIMS: To establish a set of core EBP competencies for nurses and the most important EBP learning outcomes encompassing attitudes, knowledge, and skills dimensions for implementation into nursing education in European countries. METHODS: A multi-phase modified Delphi survey was conducted: Phase 1, a literature review; Phase 2, a two-round consensus of experts; and Phase 3, a Delphi survey. Experts from six European countries participated. RESULTS: In Phase 1, 88 records were selected and 835 statements extracted, which were grouped according to the seven steps of EBP. After removing 157 duplicates, the remaining competencies (n = 678) were evaluated in Phase 2. Then, a two-round expert consensus was reached, with 24 competencies and 120 learning outcomes identified and divided into affective, cognitive, and skills domains. In Phase 3, based on a Delphi survey expert consensus, all evaluated statements were included in a final set of competencies and learning outcomes. Only two learning outcomes were recommended for allocation to a different domain, and four were reformulated as suggested, with no further changes to the others. LINKING EVIDENCE TO ACTION: The set of EBP competencies and learning outcomes can guide nurse educators, managers, and EBP stakeholders in the development of content that incorporates EBP knowledge, skills, and attitudes into educational programs. Prioritizing the EBP competencies and learning outcomes that are most necessary and adapting them to every context will provide healthcare organizations with guidelines for enhancing the continuing education of nurses. These results could facilitate the development of effective tools for assessing nursing students' and nurses' perception of competencies required for EBP processes.

Unfinished nursing care in four central European countries.

AIM: The main aim of the research was to describe and compare unfinished nursing care in selected European countries. BACKGROUND: The high prevalence of unfinished nursing care reported in recently published studies, as well as its connection to negative effects on nurse and patient outcomes, has made unfinished care an important phenomenon and a quality indicator for nursing activities. METHODS: A cross-sectional descriptive study was undertaken. Unfinished nursing care was measured using the Perceived Implicit Rationing of Nursing Care questionnaire (PIRNCA). The sample included 1,353 nurses from four European countries (Croatia, the Czech Republic, Poland and Slovakia). RESULTS: The percentage of nurses leaving one or more nursing activities unfinished ranged from 95.2% (Slovakia) to 97.8% (Czech Republic). Mean item scores on the 31 items of the PIRNCA in the total sample ranged from 1.13 to 1.92. Unfinished care was significantly associated with the type of hospital and quality of care. CONCLUSION: The research results confirmed the prevalence of unfinished nursing care in the countries surveyed. IMPLICATIONS FOR NURSING MANAGEMENT: The results are a useful tool for enabling nurse managers to look deeper into nurse staffing and other organizational issues that may influence patient safety and quality of care.

Rationed nursing care as one of the indicators of the occurrence of medication errors.

AIM: The aim was to analyze selected studies on rationed nursing care as one of the indicators that influence the occurrence of medication errors. METHODS: A descriptive review study. Articles and studies were searched in the following selected electronic databases: EBSCO (Academic Search Ultimate, Academic Search Complete), CINAHL Plus with Full Text, MEDLINE Complete, ScienceDirect and Central & Eastern European Academic Source. The search for relevant sources was based on the following English keywords: unfinished care, omitted care, rationing care, missed care, nursing care, medication errors. RESULTS: Total of 86 contributions found. After duplicit and irrelevant publications were the analysis comprised 8 primary studies and 2 systematic reviews. The studies were concerned with rationed or otherwise defined non-standard nursing care not merely related to medication errors. Each study described selected activities most frequently omitted by nurses with respect to medication: assessment of drug efficacy, medication errors, administration of incorrect drugs or doses, wrong time of administration, high-risk drug protocols and adhering to rules with each administration. The most frequently reported factor influencing the occurrence of missed care was understaffing and the related number of patients per nurse, resulting in a lack of time for selected patient activities. CONCLUSION: Despite difference in methods, all studies consistently claimed that rationed, unfinished, missed or omitted nursing care has or may have a negative impact on both patients and nurses. Some of the recommendations were increasing the number of nurses, improving team collaboration and work organization including setting systemic and preventive measures.

Measuring quality of life of cognitively impaired elderly inpatients in palliative care: psychometric properties of the QUALID and CILQ scales.

OBJECTIVES: The study aimed to assess the psychometric properties of the Czech versions of the Quality of Life in Late-Stage Dementia (QUALID) and the Cognitively Impaired Life Quality (CILQ) scales for use in the palliative care setting in terminally ill patients with cognitive impairment. METHODS: The sample comprised 306 cognitively impaired inpatients with advanced cancer and non-cancer conditions. In this cross-sectional study, two Quality of Life (QoL) measurements were performed at baseline and after five days. The dimensionality of the QUALID and CILQ scales was evaluated using a principal component analysis with Varimax rotation. Reliability was assessed using Cronbach's alpha; inter-rater reliability was evaluated with Kappa index. Test-retest stability was calculated using the intraclass correlation coefficients (ICCs) comparing scores from baseline and 3-5 days post-baseline. The construct validity of the QUALID and CILQ scale was established by Spearman's correlation coefficients with the Symptom Management at the End-of-Life in Dementia (SM-EOLD). RESULTS: Both scales were shown to have adequate validity and reliability (Cronbach's α = 0.812 for QUALID, and α = 0.73 for CILQ), good inter-rater agreement (QUALID: κ = 0.760; CILQ: κ = 0.801) as well as test-retest reliability (QUALID: ICC = 0.847; CILQ: ICC = 0.925). CONCLUSION: The Czech versions of the QUALID and CILQ scales may be recommended for use in the Czech Republic in the area of palliative care.

Predictors of Change in Quality of Life in Patients With End-Stage Disease During Hospitalization.

BACKGROUND: Currently, there are no studies aimed at evaluating the quality of life (QoL) of patients with end-stage disease during hospitalization and the factors that influence it. AIM: The aim of the research was to identify predictors of change in the QoL of patients hospitalized due to advanced stage of disease. METHODS: The sample consisted of 140 patients with end-stage disease who were hospitalized on this account. For evaluation of QoL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used. The Hospital Anxiety and Depression Scale and Karnofsky Performance Status questionnaires were used for the assessment of mental and functional status. For the evaluation of predictors of negative change in QoL, a logistic regression analysis was used. RESULTS: During hospitalization, there was a significant deterioration in the scores given for all domains of the functional QLQ-C30 scale, but not the symptomatic scale. Predictors of change in overall QoL detected were marital status, improved functional status, and depression detected on admission to hospital. Gender and age were found to be protective factors against deterioration in overall QoL. CONCLUSION: Sociodemographic characteristics and mental and functional status may be associated with change in QoL of patients with end-stage disease during hospitalization.

Quality of life in patients with diabetic foot ulcer in Visegrad countries.

AIMS AND OBJECTIVES: To identify the quality of life of patients with diabetic foot ulcers in the Visegrad countries. BACKGROUND: The diabetics with foot ulcers are principally evaluated on the basis of physical parameters, but this does not always reveal much about the patient's experience of life with ulceration. DESIGN: The cross-sectional study. METHODS: The standardised generic questionnaire World Health Organization Quality of Life-BREF was used. The sample was made up of 525 participants and the calculations were performed using the IBM spss statistical program. RESULTS: The significant negative correlations between demographic data such as age, duration of diabetes mellitus, duration of diabetic ulceration treatment and a lower level of quality of life were found across the sample. The statistically significant differences according to clinical characteristics such as Wagner classification, frequency of foot ulcers, present peripheral vascular disease and pain in terms of quality of life were also revealed. Significant differences of quality of life among Visegrad countries were revealed: Hungary's participants had a worse quality of life than others, while Slovak participants expressed lower satisfaction with their health than Czech. CONCLUSIONS: Socio-demographic factors and clinical characteristics influence the quality of life of patients with diabetic foot ulcer. Significant differences between patients of Visegrad countries were found in all domains of quality of life: physical, psychological, social and environmental. RELEVANCE TO CLINICAL PRACTICE: The quality of life of patients with diabetic foot ulcer reflects the conditions and healthcare system in each of the Visegrad countries. We have to respect socio-demographic factors and clinical characteristics in nursing care. This could have an impact on managing patient care not only with regard to their diabetic foot ulcer but also with regard to the patient as a personality with their own problems in relation to physical, psychosocial and environmental conditions.

Patients' decisional control over care: a cross-national comparison from both the patients' and nurses' points of view.

BACKGROUND: Patients' decisional control over care is the ability or power for patients to decide what their involvement will be in healthcare decisions. There is evidence of limited agreement between the perceptions of patients and the perceptions of nurses and/or caregivers with regard to the degree of patient involvement in the planning and performance of their care. AIM: To analyse and compare patients' and nurses' perceptions of patients' decisional control over their own care. METHOD: A multisite cross-sectional comparative survey design was employed. Data were collected from hospitalised surgical inpatients (n = 1315) and their caregivers (n = 960 nurses) in five European countries. The Individualised Care Scale part B was used for collecting data from both the patients and nurses. Ethical standards were followed throughout the study. RESULTS: Significant between-country differences were found between patients and nurses. In all countries, both patients and nurses regarded that decisional control over care had been actualised (ICS-B: M = 3.75-4.47 and 3.48-4.33, respectively), but there were significant differences in their perceptions regarding four of the six items of the decisional control factor of the ICS-B. CONCLUSIONS: The results show that there are disparities between patients' and nurses' perceptions of patient involvement in care, probably due to cultural issues that need further exploration. CLINICAL RELEVANCE: The disparities between patients' and nurses' perceptions on patients' decisional control over their care should be taken into consideration as a potential cause of patient dissatisfaction with nursing care.

Development and psychometric evaluation of patient needs assessment in palliative care (PNAP) instrument.

OBJECTIVE: Although assessment of palliative patients' needs is a key issue in palliative care, a suitable instrument for identification of such needs is not available in Central European countries. Our objectives were to produce an adequate tool for identifying the importance and satisfaction of palliative patients' needs and to verify its psychometric properties. METHOD: The patient needs assessment in palliative care (PNAP) instrument was constructed based on a literature review and qualitative research (focus groups, n = 5). The psychometric properties of the questionnaire were verified by a cross-sectional study. The convergent validity of the questionnaire was determined by confirmatory factor analysis. Furthermore, internal consistency, test-retest reliability, and construct validity were also tested. The qualitative research group comprised 30 participants (27 experts in palliative care, 1 patient, and 2 family members). Psychometric properties were evaluated in a group of 349 hospital inpatients terminally ill with chronic disease or cancer and receiving palliative care. RESULTS: Based on the qualitative data analysis, a questionnaire was constructed that contained 42 items grouped into 5 domains. When testing the psychometric properties of the questionnaire, a new model containing 40 items in 7 domains was produced. Cronbach's α for the entire PNAP questionnaire was 0.89 on the importance scale and 0.80 on the satisfaction scale. Test-retest reliability was higher than 0.7 for all domains in both scales. SIGNIFICANCE OF RESULTS: The results of tests on the psychometric properties of the PNAP questionnaire showed at least satisfactory validity and reliability, and it can be employed to assess the needs of palliative care patients in Central European countries.

Job satisfaction and leaving intentions of midwives: analysis of a multinational cross-sectional survey.

AIM: To investigate the relationship between turnover intentions and job satisfaction among hospital midwives from seven countries and to determine how the related variables differ between countries. BACKGROUND: Studies investigating professional turnover and job satisfaction among midwives are limited in scope. METHOD: A cross-sectional descriptive survey was used to investigate the intended turnover and job satisfaction relationship among 1190 hospital midwives in European and Asian countries. Data were collected using a set of questionnaires that included questions regarding the leaving intentions of midwives and the McCloskey/Mueller satisfaction scale. RESULTS: Midwives were least satisfied with their extrinsic rewards and professional opportunities and with the balance between family and work. Significant differences were found in all domains of job satisfaction according to midwives' intentions to leave their current workplace in hospital or profession of midwife, and to work abroad. CONCLUSION: There are some general satisfying and dissatisfying elements for the profession of midwife across different countries. IMPLICATIONS FOR NURSING MANAGEMENT: The results highlight the importance of understanding midwives' leaving intentions and related factors across different countries. To prevent midwife turnover, health-care managers should gain greater insight into the early stage of midwives' turnover intention.

Psychometric Properties of the Slovak and Czech Versions of the Evidence-Based Practice Beliefs and Implementation Scales.

BACKGROUND: The Evidence-Based Practice Beliefs (EBP-B) and Evidence-Based Practice Implementation (EBP-I) scales are psychometrically sound instruments that were used, within an educational setting, to systematically study students' beliefs about and their implementation of evidence-based practice (EBP). Czech and Slovak versions of these instruments were developed and evaluated using a sample population of nursing students. PURPOSE: The purpose of the study was to test the psychometric properties of the Czech and Slovak versions of the EBP-B and EBP-I scales. METHODS: Psychometric properties were evaluated using a sample of undergraduate and graduate (nearly graduated) nursing students (n = 223) completing EBP courses. To test psychometric properties of the questionnaire, its reliability and validity were explored. Cronbach´s alpha was computed to evaluate internal structure and internal consistency. RESULTS: The Slovak versions of both the EBP-B and the EBP-I scale have good internal consistency (Cronbach's alpha: .82 and .94, respectively). Similarly, the Czech versions of the EBP-B and the EBP-I scales both have good internal consistency (Cronbach's alpha: .85 and .89, respectively). LINKING EVIDENCE TO ACTION: The results of psychometric analysis of the Czech and Slovak versions of the EBP-B and the EBP-I scales are consistent with the results of the original study and indicate that the Czech and Slovak versions have the potential to be valid, reliable, and sensitive instruments for measuring an individual's beliefs about the value of EBP and their ability to implement it. Both instruments can be used to assess changes in nurses´ beliefs about EBP over time as well as the effectiveness of strategies aimed at promoting the use of evidence in practice.

Quality of life and needs of hospitalized schizophrenic patients in the Czech Republic.

OBJECTIVES: The main aim of the study was to investigate the quality of life and the medicinal and social needs of patients hospitalized with schizophrenia in the Czech Republic to uncover potential issues in these areas. METHODS: Relevant self-evaluating questionnaires (SQUALA for quality of life; CANSAS for medicinal and social needs) were used in a cohort of hospitalized schizophrenic patients undergoing rehabilitation before discharge from the mental hospital. RESULTS: Two hundred and forty-four patients (women N=115) aged 18-58 years were involved in the study. The quality of life of hospitalized patients with schizophrenia was subjectively assessed as universally worse in comparison with the general Czech population (p<0.05 in most cases; two-sample Student's t-test), but patients were not wholly critical of their own health status and overestimated its quality (arithmetic mean 63.79 in the patients vs the range of 45.5-59.8 as the norm in the general Czech population). Intimate relations, financial matters, treatment of psychotic symptoms, and sexual life were among the most pressing medicinal and social needs in our study subjects. CONCLUSION: The results of our study should stimulate psychiatric nurses in their effort not only to detect but also address the problems of schizophrenic patients concerning quality of life and unfulfilled needs. This can be done via education, guidance towards a healthy lifestyle, or providing patients with adequate exercise. Overall this issue is of significant importance in the Czech Republic due to the fact that legislative reform of mental health care emphasizing community care and psychiatric nursing has just been implemented.

Students' and families' expenditures to attend a nursing programme in 2011-2012: a comparison of five southern European countries.

AIM: To compare students' and families' nursing education expenditures across Europe. BACKGROUND: Nursing education costs are affected by investments in public education. The remaining costs fall on the shoulders of students and their families. While remaining somewhat understudied, public and student expenditure for nursing education is becoming critical in the current crisis context. Comparative studies on education costs are inevitably affected by a currency bias. Therefore, a standard measure named the Purchasing Power Standard, which has received no attention in nursing research, has been introduced. DESIGN: A mixed-method study incorporating qualitative and quantitative study designs was undertaken in 2011-2012. METHODS: Five nursing faculties located in the Czech Republic, Greece, Italy, Slovakia and Slovenia were included in the study. A questionnaire evaluating students' expenditures was developed in five languages and validated. Six hundred and twenty-five full-time students were recruited. RESULTS: A Slovakian student wishing to pursue a nursing career is required to commit an amount of money per year that corresponds to 15% of the average annual income of a Slovakian citizen. Lower percentages were required by students in Greece (10%), Italy (11%) and Slovenia (12%), while Czech students bore the lowest costs (5%). CONCLUSION: None of the countries involved was supporting nursing students through either direct or indirect financial incentives. Students in some countries were also required to buy and maintain uniforms. There is a need to develop supportive policies, especially in those countries where nursing programmes are expensive and may not be accessible to all talented and motivated students due to limited public support in education and the current economic context.

[The level of job satisfaction and its relation to midwives' subjective quality of life]. / Analiza poziomu satysfakcji zawodowej oraz jej zwiazku z subiektywnie oceniana jakoscia zycia poloznych.

BACKGROUND: According to the so called Transactional Model of Quality of Life, job satisfaction is a part of subjective well-being. The aim of this study was to explore the relationships between professional commitment, expressed as job satisfaction or dissatisfaction, consideration of leaving the profession or/and workplace, and subjective assessment of well-being among midwives working at hospitals. MATERIAL AND METHODS: The study was a part of the international research project, coordinated by the University of Ostrava. The group of respondents consisted of 176 midwives working at selected hospitals in the Silesian region. The study was conducted using the method of diagnostic survey, questionnaire techniques and standardized research tools, such as McCloskey/Mueller Satisfaction Scale (MMSS), Personal Wellbeing Index-Adult (PWI-A) and Subjective Emotional Habitual Wellbeing Scale (SEHP). RESULTS: The overall midwives' job satisfaction was found to be at a medium level. Respondents less satisfied with various aspects of work (interaction, co-workers, professional opportunities, praise/recognition, control/responsibility) and life (standard of living and achievements in life) were significantly more often considering changing their jobs. Dissatisfaction with the extrinsic rewards (salary, vacation, benefits package) had additionally influenced the frequency of considering changing the profession. The respondents were characterized by much lower sense of present and future security than that observed in Western countries, as well as by low satisfaction with standard of living and feeling part of the society. CONCLUSIONS: Job satisfaction and subjective well-being remain in strong relationship, and although it is difficult to determine the direction of these relationships, they seem to have a significant impact on each other.

Inadequate number of staff and other reasons for implicit rationing of nursing care across hospital types and units.

AIM: The aim of the study was to find differences in perceived reasons for implicit rationing of nursing care across hospital types and units. DESIGN: A descriptive multicentre study. METHODS: The study in 14 Czech acute care hospitals was conducted from September 2019 to October 2020. The sample consisted of 8316 nurses working in medical and surgical units. Items for rating the reasons for implicit rationing of nursing care were selected from the MISSCARE Survey. Nurses were asked to rate each item on a scale from 0 (a not significant reason) to 10 (the most significant reason). RESULTS: The most significant reasons for implicit rationing of nursing care were 'Inadequate number of staff', 'Inadequate number of assistive personnel' and 'Unexpected patient admission and discharge'. Most reasons were rated as more significant by nurses from non-university hospitals. Nurses from medical units perceived all reasons for implicit rationing of nursing care as more significant.

Satisfaction with nursing care of hospitalized patients: A descriptive, cross-sectional, multicenter study.

BACKGROUND: In the assessment of healthcare processes focusing on the quality of care provided, patient satisfaction is an important indicator that healthcare providers may use for future setting of healthcare and preventing adverse events. The study aimed to determine satisfaction with nursing care among hospital inpatients. MATERIAL AND METHODS: The sample comprised 14 023 patients staying in medical and surgical wards of 14 acute care hospitals in the Czech Republic in 2019-2020. Data were collected using the Patient Satisfaction Scale, a standardized tool containing 11 items in 3 subscales. Data analysis included descriptive statistics and correlation analysis (Spearman's rank correlation coefficient). RESULTS: Overall, patients reported high satisfaction with nursing care (M = 3.57). Patients were most satisfied with how their technical/rational needs were met (M = 3.57); the least satisfaction was identified in the domain of information needs (M = 3.53). Patients who perceived their health as good (47%) or very good (18%) showed high satisfaction scores (M = 3.77 and M = 3.73, respectively). High scores were also achieved for patients with secondary (M = 3.58) and tertiary (M = 3.59) education, those whose admission was planned (M = 3.59) and those staying in large hospitals (M = 3.60). There were no differences in satisfaction with regard to gender (p = 0.755) and the COVID-19 pandemic (p = 0.190). CONCLUSIONS: Patients' satisfaction with care provided is a highly significant parameter of healthcare quality. It is influenced by a number of aspects which, if adequately defined, may aid in improving the quality of care. Med Pr Work Health Saf. 2023;74(6):461-8.

Self-assessed competence of final-year nursing students.

AIM: To examine the overall level of self-assessed competence of final-year nursing 'bachelors' degree students in the Czech Republic. In addition, the study aimed at the factors associated with the students' level of competence. DESIGN: A cross-sectional observational study. METHODS: Data were collected with the Czech version of the Nurse Competence Scale from 274 final-year nursing students of the bachelor's nursing program. Data were analysed using descriptive statistics and multiple regression analyses. RESULTS: Majority of the students (80.3%) assessed their level of competence as good or very good. The highest level of competence was assessed in the category of 'managing situations' (VAS mean 67.8) and 'work role' (VAS mean 67.2). Previous work experience in healthcare and successful supervisory experience had a positive association with self-assessed competence. Students who completed clinical placement during the COVID-19 pandemic assessed their level of competence as lower than students before the pandemic. No Patient or Public Contribution.

A cross-cultural study of the concept of caring through behaviours: patients' and nurses' perspectives in six different EU countries.

AIM: This paper is a report of an international study of patients' and nurses' perceptions of nurse caring behaviours. BACKGROUND: Current economic constraints on healthcare systems, demand to increase the quality of care and the incorporation of the consumers' perspective into care, have created a need to develop a clear understanding of nursing behaviours which convey caring. Patients in different areas of the world report different expectations of nurses' caring actions when compared to nurses' views. METHOD: A descriptive comparative survey design was used to analyse a sample of surgical patients (n = 1659) and their nurses (n = 1195) in 88 wards of 34 hospitals in Cyprus, the Czech Republic, Finland, Greece, Hungary and Italy. Data were collected in autumn 2009 using the Caring Behaviours Inventory-24. Nurses' and patients' responses were compared using both inferential and descriptive statistics. RESULTS: Independent samples t-tests showed important differences between nurses' and patients' views. Although both groups perceived knowledge and skill as being the most important sub-scale, the nurses' responses were higher compared to patients (P < 0·05) with important differences in the 'assurance of human presence' (P < 0·001) and the 'respectful deference to others' (P < 0·001) sub-scales. Cross-country comparisons showed important differences between the nurses' (F = 24·199, P < 0·001) and patients' views on caring (F = 26·945, P < 0·001). CONCLUSIONS: Important differences were observed between patient-nurse perceptions in the participating countries. The results form a foundation for future research into the development of a common international perspective about caring behaviours between patients and their nurses.

Patients' and nurses' perceptions of individualised care: an international comparative study.

AIM: The aim of this study was to compare patients' and nurses' perceptions of individualised care in five European countries, the Czech Republic, Cyprus, Finland, Greece and Hungary. BACKGROUND: Individualised nursing care has been studied from both patients' and nurses' perspectives, but to date, there are no studies comparing these perspectives internationally. METHODS: A cross-sectional comparative survey design was used. Data were collected from nurses (n = 960; response rate, 79%) and patients (n = 1315; response rate, 78%) in 71 surgical units from 26 acute hospitals in 2009. Data were collected using two Individualised Care Scales (ICS-Nurse and ICS-Patient) and analysed statistically using descriptive and inferential statistics. RESULTS: Differences in patients' and nurses' assessments of individualised nursing care were found between each country. Nurses, compared with patients, assessed that they supported patient individuality more often. The Mean(nurses) ranged from 3·61 (SD 0·90, Greece)-4·31 (SD 0·53, Hungary), and the Mean(patients) ranged from 3·05 (SD 1·09, Greece)-3·79 (SD 1·00, Cyprus). To a large extent, the care provided was individualised as defined by the Mean(nurses) 3·75 (SD 0·92, Greece)-4·36 (SD 0·49, Hungary) and the Mean(patients) 3·41 (SD 0·95, Greece)-4·18 (SD 0·79, Cyprus). In Cyprus and Finland, patients' assessments of the individuality in their care corresponded well with nurses' assessments. Clear between-country differences in both patients' and nurses' assessments were found in both subscales of the ICS. CONCLUSIONS: An in-depth analysis of the European between-country differences is required to define the causes of differences that may be due to the differing content of education, the organisation of nursing work, ideology and values assigned to individualised care and health care systems and processes in each country. RELEVANCE TO CLINICAL PRACTICE: Obtaining both patients' and nurses' assessments of individualised care may facilitate the further development of individualised nursing care and be used to help to harmonise European health care processes and nursing care.